Analyzing the practice of medical humanistic care based on a social learning model: mapping the trajectory of the learning dynamic process from the learner's perspective.

Background: Humanistic care is a good glue for the doctor-patient relationship, and it is a general trend to improve the practice of humanistic care. Methods: A narrative research method was used to conduct semi-structured interviews with 18 master's degree nursing students from China who were in the clinical rotation stage, and the data were content analyzed and explored from the perspective of the learners who were learning about humanistic caring practices using the social learning theory model. Results: There is a triple tension structure in the practice of humanistic care: At the cognitive level, there is a knowledge-activity rupture, with learners showing theoretical clarity but practical confusion. At the environmental level, it is divided into the dual role of facilitating and inhibiting environments. "rewarding" environments included positive psychological attitudes of patients, caring-friendly departmental environment, perceptually rewarding mindfulness environment, and loving family environment. In contrast, "punishing" environments included patients' irresponsible attitudes toward themselves, poor care experiences, inflexible management mechanisms, missing incentives. At the behavioral level, there is a dialectical game between constructive and alienating practices. "forward" behaviors included personalized care in the details, respect for patient autonomy, proactive communication and empathy, systemic support and teamwork. Conversely, "backward" behaviors included mechanized procedures and emotional detachment, disregard for privacy and dignity, systemic issues that exacerbate apathy. Conclusion: Based on the framework of social learning theory, this study constructs a learning trajectory model of humanistic care to explain the synergistic mechanism between cognitive dimension and environmental system and its two-way shaping of caring practice behavior. The study finds that there is a "black box" phenomenon in which the theory of humanistic care is clear but the practice of humanistic care is confusing in the cognitive dimension, and in the environmental dimension, there are systematic limitations in the traditional biomedical model. Based on the above two-dimensional analysis, this study proposes an optimization path combining cognitive explicit cultivation and environmental support system reconstruction, which points out the direction for breaking through the dilemma of humanistic care practice.